Sports Dentistry

With athletes losing an estimated 5 million teeth every year from playing the sports they love, dental assistants have a huge opportunity to be the team hero in the esthetic zone

Sports dentistry devotes itself to the treatment of athletes for injury prevention or the treatment of injuries sustained in athletic competition. "It's a lot of fun for our staff and the other patients in our office to know that we're the Tampa Bay Rays' team dentist and we take care of them," says Jeff Scott, DMD, who sees sports dentistry as a combination of treatment and prevention, with services differentiated into urgent and optional categories. For example, a player whose wisdom teeth are bothering him during Spring Training requires urgent care before the season starts. "In cases like this, the question is always, 'How long will it take to recover?' Players do not want to miss one second of practice," he says. "During Spring Training, a lot of players are trying to make the big league team and not get sent to the minors, so they are reluctant to have any dental work done unless it can be done quickly."

As George Kirtley, DDS, team dentist for the Indiana Pacers basketball team, explains, "The purpose of sports dentistry is to first prevent, if possible, any injury to the dentition, and secondly to treat, if necessary, any injury to the dentition. Injury prevention involves educating the athlete about protecting their teeth by using a mouthguard."

Treatment & Prevention in Sports Dentistry

Sports injuries to the mouth and oral environment are not only disfiguring, Kirtley says, but they cost time-either away from school or work-and they certainly become expensive. These are important considerations, and they're unfortunate, because many sports-related mouth injuries can be easily prevented with the proper design of mouth and tooth protection through mouthguards, he says.

Mouthguards-At the Center of it All

According to Emilio Canal, Jr, DDS, the 2010-2011 immediate past president of the Academy of Sports Dentistry, mouthguards can help athletes prevent injury by protecting the hard tissue-such as the teeth and jawbones-as well as the soft tissue, but it is critical that the mouthguard fits properly. If the mouthguard does not fit properly, athletes often complain that it is cumbersome, that they can't speak or breathe with it, and then they won't wear it, he says.

"Mouthguards are protective safety equipment in sports, so they need to be properly fitted. It's no different than a helmet," Canal explains. "You're not going to give a football player a helmet that's five times bigger than what he needs, because he's going to run around and it will be moving all over the place. If he gets hit, it's not going to protect him. One of the biggest issues we have as sports dentists is making sure we educate coaches and players that a mouthguard doesn't impede you from speaking or breathing properly if it's properly fitted, and that what they have had in the past was probably something that was really inadequate."

There are a number of mouthguard choices available. Jay Turkbas, senior vice president of product development for mouthguard company Shock Doctor says it can be universally agreed on by most professionals that the lower-end, one-layer mouthguards are inferior to dentist-made mouthguards as well as the multilayer, self-customizing mouthguards that can be purchased at sporting goods stores. Although the Academy of Sports Dentistry recommends custom mouthguards made by a dentist, Turkbas says another viable option is the new generation of multilayer, self-fitting mouthguards.

"The boil-and-bite mouthguards provided to high school and association teams by schools and organizations, which are very often free, are also usually at the low end of quality-they don't fit and, therefore, perform poorly," Turkbas explains. "We don't agree with that practice and neither do dentists. Higher-quality mouthguards are, of course, more expensive, and this concern for budget over safety often drives these decisions by schools or associations. This is a huge disservice to kids unless their parents can buy a better boil-and-bite or a dentist-fabricated custom mouthguard."

"Sometimes, just because of bad luck, somebody will trip and fall. They'll hit their face, and their mouth can be injured," William Balanoff, DDS, MS, a private practitioner in Ft. Lauderdale, Florida, imparts as an example for the everyday need for mouthguards. "This idea that sports dentistry is for the 12- to 25-year-old patient is wrong. What I'm finding more and more is that a lot of my older patients are participating in sports and injuring themselves, sometimes in the craziest and most unique ways."

Balanoff predicts that dentists will begin to notice many people becoming involved in sports in some form or another, not just kids. In his own practice, he sees many patients who are well into their 70s and 80s who either ride a bicycle or enjoy walking or jogging, each of which is a sports activity, he points out.

Tales from the Sidelines

Kirtley believes that what makes sports dentistry unique among dental disciplines is the manner in which it enables the dental team to combine their professional skills with their love of sports in a rewarding way. Getting to meet some of the interesting personalities involved in professional sports over the years also adds to the joy of it all, he says.

But the joys associated with supporting a beloved sports team in a professional capacity can many times be tempered by the realities of the dental injuries that the athletes sustain. As our interviewees recall, some sports dentistry emergencies are interesting, yet horrifying.

Nothing but Net...and Luxated Lower Anterior Teeth

Kirtley, who's been practicing sports dentistry for 25 years, recalls a graphic example of a dental injury sustained by an athlete during a game a few years ago between the Indiana Pacers and the Orlando Magic, at a time when Shaquille O'Neal still played for them. During the close of the first half, Vern Fleming, the Pacers guard, drove to the basket. O'Neal aggressively defended the basket, knocking Fleming to the floor, then falling on top of him.

"The physics of 320 pounds falling on someone who is 180 pounds is fairly obvious, and it resulted in significant injuries to Vern," Kirtley says. "We took Vern to the locker room and assessed his injuries. His lower teeth were luxated anteriorly, and he had bitten completely through his lower lip and severely fractured his upper six teeth."

Kirtley kept a dental injury emergency kit in the locker room that contained things such as anesthetic, syringes, composite resins, and splinting material. During the preseason examinations that he'd performed on all of the Pacers' team players, Kirtley had taken impressions, had models poured of each of them, and had mouthguards made, along with duplicates that were kept in the locker room.

"Unfortunately, some players didn't wear their mouthguards, and Vern was one of them," Kirtley admits. "But because I had the models and had made the mouthguards, I at least had a means to stabilize his injured upper dentition until I could see him in my office the next day. However, we had to treat the significant injuries he sustained at that moment in the locker room."

Getting Involved

"The players you work with-no matter at what level-are always very appreciative of what you're providing to them," Canal says of being involved in sports dentistry. "You're part of the game, and you are on the field because you're part of the medical team. You're in the locker room. Sometimes you travel with the team. The gratitude you get from the kids and the comments you receive from players in general-it's just terrific."

Most dentists-and, therefore, their dental assistants-do not have professional sports teams in their hometowns. So what should a dental assistant interested in sports dentistry do to get involved? Kirtley suggests becoming associated with one of the high schools in your area, such as the one your children attend, and propose to your dentist that he or she offer to make mouthguards for all the team members who want them in any sport that they are participating in. Dental practices in rural communities can certainly offer this service to teams in the schools or to athletes that are competing on an amateur level as a means to get involved in sports dentistry, he says.

Although this represents an initial cost to the dentist, it is a loss leader, Kirtley explains. He's providing the athletes with something of great value to their health through the prevention of injury. The student athletes go to him, and he makes the mouthguards in his office. The custom-designed mouthguard provides the standard of care in protection, which is Kirtley's main concern, and the experience provides a good public relations opportunity for his office and staff.

"Many times I'll get new patients from it, but that's not the entire reason I do it," Kirtley says. "It's an opportunity to give something back, and it doesn't cost a lot except some of my time and some materials."

Canal agrees that the best place to start practicing sports dentistry is in your own community. "That's where a dental practice can build a reputation. There are so many high schools that are underserved as far as being provided proper oral protection," Canal observes. "Many of these kids who are playing football and lacrosse go into high school and are given a token mouthguard that doesn't fit properly, so they're not wearing them."

He further suggests meeting with families in the communities, which will further help dentists and dental assistants build their sports dentistry practice. Then, Canal strongly encourages both dentists and dental assistants to attend meetings and forums sponsored by the Academy for Sports Dentistry, which provides venues for networking as well as education.

Education & Training

Kirtley agrees. "The Academy of Sports Dentistry provides its members and interested practitioners, who are not necessarily members, with education in this area. It is a great resource and the leading source of sports dentistry information, and it provides outstanding courses."

"For dentists working in the capacity of a team dentist for different colleges or sports teams, the Academy of Sports Dentistry is the only place where they can get relevant, updated information about what's new-including treatment, prevention, and performance mouthwear-related to sports dentistry," Canal says of the group that was established in 1983. "Our membership is a nice mix of more than 500 sports dentists, laboratory technicians, dental hygienists, dental assistants, and athletic trainers from the United States and Canada, as well as other countries in Europe and South America."

Conclusion

Sports dentistry is an exciting adjunct to most dental practices that, for the most part, goes untapped, Balanoff says. In fact, he doesn't think patients truly understand all that dentists can do for them with respect to injury protection and prevention. With the dental assistant's help, dentists should evaluate their patient population and begin having conversations with their patients about all that modern dentistry can do with respect to sports dentistry, he adds.

"Sports dentistry has really provided another dimension to my experience in the profession. The rewards of being associated with a professional sports team and providing care for its players have given me credibility that has directly helped me build my cosmetic restorative practice," Kirtley shares. "This is simply just a by-product of enjoying what I do and helping to make a difference outside the circle of what I do in my everyday practice. There is a great need for all of us in dentistry to be versed in this field. It has many, many rewards."

But Canal adds that equally necessary is delivering sports dentistry to athletes at a certain standard of care, and that's where the Academy of Sports Dentistry can be a resource, he says. Whether from the youth level to the professional level, dentists and dental assistants must be educated on what is right when it comes to mouthguards and injury protection, and obtaining information from a reputable source about what is proven, researched, and recommended is of paramount importance, he adds.

"There is no reason why you can't provide that care to high school athletes or even college players who are already patients in your practice. You should be able to ask, 'Are you getting a good mouthguard? What are you using for prevention when you play sports?'," Canal says. "If they don't have something, your dentist should be able to provide it. That's why I feel that sports dentistry is for everybody. It's not just for those doctors working with professional or college teams."

Allison M. DiMatteo, BA, MPS